School Profile Form for Remote Coaching

Fields marked with an asterisk are required information. The other fields, when answered, will help us prepare for a follow-up call with you. Please answer as completely as possible.

School *

City *

State *

Main Contact

Name *

Title/Position *

Email *

Phone *

Information on grade levels, programs, instructors and students who will be part of remote coaching support.

	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Pre-K	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Grade K	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Grade 1	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Grade 2	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Grade 3	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Grade 4	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Grade 5	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Grade 6	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Grade 7	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Grade 8	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Grade 9	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Grade 10	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Grade 11	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Grade 12	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use
Special Education	# of Teachers	# of Assistants	# of Students	List DI Programs and Levels in Use

Connectivity

What is the average capacity for distance learning for families with regard to:

Access to internet at home or within the community? *

At-home devices such as computers, tablets and/or phones? *

Distance Learning

What has already been done to begin distance learning and/or with sharing instructional packets with students?

What has already been done to determine how to break students into instructional groups and how to allot instructional time for students who are below grade level, on grade level or above grade level?

Previous Training and Program Coaching

Have instructors attended program training?

Yes

No

Please provide more information as relevant.

Have instructors received onsite program coaching of DI lessons?

Yes

No

Please provide more information as relevant.